A group of congressional leaders has requested a meeting with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to discuss evidence pointing to widespread Medicare fraud in Los Angeles County. The letter was authored by Congressman Brett Guthrie, Chairman of the House Committee on Energy and Commerce; Congressman John Joyce, M.D., Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations; Congressman Morgan Griffith, Chairman of the Energy and Commerce Subcommittee on Health; Congressman Jason Smith, Chairman of the House Committee on Ways and Means; Congressman David Schweikert, Chairman of the Ways and Means Subcommittee on Oversight; and Congressman Vern Buchanan, Chairman of the Ways and Means Subcommittee on Health.
“The House Committee on Energy and Commerce has an extensive history of digging deeper into matters where program integrity has been compromised. This letter is crucial in our commitment to eliminating waste, fraud, and abuse in federal health care programs,” said Chairmen Guthrie, Joyce, and Griffith. “Republicans have spent much of this Congress furthering legislation to protect our most vulnerable Americans—especially seniors, but our work is not done. Continued oversight is crucial to uphold the integrity of programs that serve our most vulnerable populations. We applaud the ongoing work being conducted by HHS-OIG in cracking down on the fraud that has occurred, and we look forward to addressing the larger-scale scheme that is draining public resources from Americans who need these services the most.”
“Medicare home health and hospice fraud directly undermines the safety and reliability of care for America’s most vulnerable seniors. Auditors have reported an unprecedented jump in home health and hospice fraud in Los Angeles County, California – including one report showing 112 different hospices located at the same physical address. With $1.2 billion in improper payments in home health claims and the Inspector General reporting $198 million in suspected hospice fraud, Gavin Newsom’s California could just as well be another Minnesota,” said Chairman Smith.“The Ways and Means Committee will not hesitate to use our broad oversight authority to get to the bottom of this and protect taxpayers and vulnerable patients against these bad actors.”
Recent findings suggest that fraudulent activities involving home health agencies (HHAs) and hospice providers are becoming more common in Los Angeles County. The Centers for Medicare & Medicaid Services (CMS) found that about 7.7 percent—or $1.2 billion—of home health claims were improperly paid in 2023. For hospice care alone, suspected fraudulent activity totaled approximately $198 million during fiscal year 2023.
There has been a notable increase in new HHAs operating within Los Angeles County even as numbers nationwide have declined slightly since 2019. While there were fewer than 8,300 HHAs across the United States by June 2023—a decrease from previous years—the number operating locally grew by nearly half over roughly four years.
According to data from a March 2022 report by California state auditors along with HHS figures regarding ownership trends among hospices nationwide: more than 31 percent of all U.S.-based hospice agencies operated within Los Angeles County as recently as 2022.
California state auditors estimated that local hospice agencies may have overbilled Medicare by $105 million during 2019 alone due to practices such as clustering multiple licensed facilities at a single location.
In response to concerns about inadequate scrutiny from Accrediting Organizations overseeing Medicare enrollment for these providers:
- CMS issued guidance late last year instructing surveyors reviewing enrollment documents for possible changes related to ownership or location.
- HHS OIG announced plans earlier this year for an audit examining patterns associated with new enrollments among Medicare hospice providers.
- Law enforcement task forces dismantled several local hospices tied to organized crime following a multi-year investigation completed earlier this year.
- CMS recently commented through regulatory rulemaking that it intends further action targeting identified vulnerabilities within payment systems affecting home health providers.
